| NPI | 1932235470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 47664) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A96692) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2010-05-21 |